From the Research
Incidental mesenteric panniculitis found on imaging should be managed with monitoring without immediate intervention, as it is a benign condition with a favorable prognosis. The most recent and highest quality study, 1, published in 2025, suggests that mesenteric panniculitis is a rare disease characterized by chronic inflammation and fibrosis of the mesenteric adipose tissue, and that medical treatment is unnecessary for asymptomatic patients.
Key Considerations
- Confirm the diagnosis with a radiologist to ensure it's truly mesenteric panniculitis and not another condition requiring urgent attention.
- For asymptomatic patients, watchful waiting with follow-up imaging in 6-12 months is appropriate to monitor for changes.
- If the patient develops symptoms like abdominal pain, nausea, or changes in bowel habits, further evaluation is warranted.
- For symptomatic cases, treatment options include NSAIDs for mild symptoms, or corticosteroids (such as prednisone) for more significant symptoms, as suggested by 2 and 3.
Treatment Options
- Corticosteroids, such as prednisone, are a first-line treatment option for symptomatic cases, with a dosage of 40-60mg daily and gradual taper over weeks to months.
- Other medications, such as tamoxifen, colchicine, or immunosuppressants like azathioprine, may be used in refractory cases.
- Surgery is reserved for cases of recurrent bowel obstruction, as stated in 2 and 4.
Underlying Causes
- The underlying pathophysiology involves inflammation of the mesenteric fat, which can be idiopathic or associated with other conditions like IgG4-related disease, prior surgery, or malignancy.
- It's essential to evaluate for these underlying causes, particularly malignancy, as mesenteric panniculitis can sometimes be a paraneoplastic phenomenon, as mentioned in 2 and 4.